The Food and Drug Administration (FDA), declared teen use of electronic cigarettes, or e-cigs, has reached “an epidemic proportion.” The federal agency, among other functions, is tasked with the responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors.

The FDA notified manufacturers of the most popular e-cig devices that they have only 60 days to ensure they have the capability of controlling underage use of their devices.

If five major manufacturers, including the popular Juul Labs, do not deliver a solution in that time frame, the agency could remove their products from the market and suggested civil or criminal charges for manufacturers that allow bulk sales.

Federal law prohibits the sale of e-cigarettes to anyone under 18. The agency issued warnings to 1,100 retailers and additional 131 fines for selling e-cigs to minors.

FDA commissioner Dr. Scott Gottlieb said more than 2 million middle and high school students used e-cigarettes in 2017.

The move by the FDA symbolizes a changing perspective in the public health community. E-cigarettes have been widely seen as a healthier alternative to traditional cigarettes because of their lack of toxic chemicals.

However, the devices have developed into another public health issue: teenagers getting addicted without having smoked a traditional cigarette, as most devices contain higher levels of nicotine.

“The developing adolescent brain is particularly vulnerable to addiction,” the FDA said in its statement announcing the actions.

The spotlight of the agency was particularly focused on Juul, which launched their device in 2015 with the sleek look of a flash drive that delivers especially potent hits of nicotine. In less than three years, Juul has come to dominate the market, particularly among students and minors, controlling about 72 percent of the e-cigarette market.

“Juul Labs will work proactively with FDA in response to its request,” a Juul spokesperson said in a statement. “We are committed to preventing underage use of our product, and we want to be part of the solution in keeping e-cigarettes out of the hands of young people.”

Dr. Gottlieb expressed that if “straw sales” are happening, in which manufacturers make bulk sales via their websites that make it easier for minors to attain e-cigarette devices, it should be clear. “If the companies don’t know, or if they don’t want to know, we’ll now be helping to identify it for them,” Dr. Gottlieb said.

Dr. Gottlieb expressed that he and the FDA believe that e-cigarettes and similar products may be an effective countermeasure to adult smoking, but the agency must take necessary action to address the rapidly increasing rates of underage use and availability.

“Inevitably, what we are going to have to contemplate are actions that may narrow the off-ramp for adults who see e-cigarettes as a viable alternative to combustible tobacco in order to close the on-ramp for kids,” Dr. Gottlieb said. “It’s an unfortunate trade-off.”